Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series

Abstract

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The Guerilla Tactics of Hepatitis B Virus in Hemodialysis: Fighting a Stubborn Foe

“…2 These efforts have led to a 95% decline in HBV infections over time and a stable seroprevalence of 1% in dialysis facilities since 1995. 2 However, the case series of HBV mutant infections reported by Apata et al 3 in this issue of Kidney Medicine is an uneasy reminder that the war against HBV is still ongoing. Specifically, guerilla-like tactics employed by rare but emerging mutant virus strains could create new dangers in hemodialysis facilities.…”

“…Development of a diagnostic algorithm for patients with discordant serologic profiles over time might help identify at-risk patients because the presence of different HBV markers may vary on an individual basis at different time points and potential exposures. 3,11,13 However, this seems an unrealistic approach in the real world for practicing clinicians, who are not virologists and may not recognize the patterns of possible occult HBV infection without access to complete medical records and the benefit of seeing the entire picture of testing over time.…”

“…Although it is beyond the scope of this editorial to make recommendations about industry laboratory standards, it would seem wise for dialysis organizations and their affiliated laboratories to weigh the pros and cons of adopting one of the currently available commercial platforms that can detect the most common HBV mutant surface antigens. 3 This may be economically attractive in the long run, especially in light of the potential downsides of a public health investigation and its associated costs. Furthermore, this would provide additional safeguards against variability in HBsAg assays and infection control practices in the community because dialysis patients may be exposed to HBV in hospital and other settings.…”